Given COVID-19's devastating impact on long-term care facilities, more and more individuals and families are interested in finding alternatives to traditional institutional care settings. Residents of nursing homes and other long-term care facilities account for a disproportionate share (40 percent as of December 15, 2020) of coronavirus-related deaths in the United States, despite representing less than 1 percent of the population. A major driver of widespread transmission of COVID-19 in traditional nursing homes was the physical environment of these settings--typically large buildings with shared living spaces. Even before the coronavirus pandemic, long-standing problems in traditional nursing homes, such as infection control violations, low staffing ratios, and safety concerns, led some individuals and their families to seek alternative options, including small-house nursing homes. Small-house nursing homes incorporate design elements that enable a safer living environment for people in need of nursing-home levels of care (see sidebar, p. 2). THE GREEN HOUSEĀ® model, which generated national interest with its inception in the early 2000s, is the most widely researched small-house nursing home today. This report describes key elements of the Green House model, with a focus on its housing, services and supports, workforce, and community integration. Also discussed are opportunities to expand the availability of both Green House homes and similar small-house nursing homes, as well as challenges associated with the model.
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